[MEP-15] Arch Replacement in An Elderly Patient With Multiple Comorbidities.

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Aortic arch aneurysms pose significant surgical challenges, particularly in elderly patients with multiple comorbidities.
• Managing these complex cases requires tailored surgical strategies to minimize risks and optimize outcomes.

Purpose of the Study:

• To present a case of extensive aortic arch aneurysm repair in an elderly patient with significant comorbidities.
• To highlight the effectiveness of extended hemiarch replacement combined with unilateral anterior cerebral perfusion (ACP).

Main Methods:

• A 76-year-old male with an 8-cm ascending aorta and arch aneurysm underwent median sternotomy.
• The patient received unilateral anterior cerebral perfusion (ACP) via the innominate artery during hypothermic circulatory arrest.
• An extended hemiarch replacement was performed using a 26-mm straight graft.

Main Results:

• The surgical repair was completed with a 35-minute period of ACP and lower body ischemia.
• The patient experienced an uneventful recovery with no neurological deficits.
• One-year follow-up computed tomography confirmed a durable repair.

Conclusions:

• Extended hemiarch replacement with unilateral ACP is a safe and effective approach for complex aortic arch aneurysms in high-risk elderly patients.
• Conventional surgical techniques remain the gold standard, even in the presence of comorbidities, when adapted appropriately.